Hello and thankyou for approaching DoctorSpring with your query.
I am sorry for your patient
Earlier Reporting of low output from ileostomy may have benefited the patient. However ileostomy output was just marginally decreased and hence earlier reporting would not have made a major difference in the final outcome of the patient.
Again NG tube should have been placed once the patient had vomiting, pain abdomen and distension. I don't know why your MD didn't ordered for it. Probably he might have thought distension might be due to ascites.
Patient might have developed intestinal obstruction or paralytic ileus, or even perforation peritonitis as the actions were delayed in an already a compromised patient, this might have been the cause for all sudden events. The MD must have had his reasons, clinical findings and judgements in taking the treatment call.
I hope this has helped.
Feel free to follow up. Thankyou
Patient replied :
Thanks for your help! I keep thinking if I had reported the low output earlier the MD may have ordered the KUB earlier, but the other nurses told me he would probably have just watched the output overnight and ordered it the next day anyway. I thought the output may have been decreased because the patient was not eating, but does intake affect the amount of output? Others have said pt was headed for a bad outcome anyway after he refused the PEG tube but I am just wondering if there is anything I could have done differently
Ileostomy output will be less if patient is not taking orally, but it will not be 200ml in 24hrs. It may be some where around 400 to 500ml.
I don't think you could have something better than this, possibly your MD knew that patient had grave prognosis, he reacted like that.